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100問 • 1年前

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It is necessary to evaluate the effectiveness of antibiotic therapy in outpatient with community-acquired pneumonia after:

48-72 hours from the start of administration

When a clinical diagnosis of community-acquired pneumonia is made in primary care, to determine the risk of patient's death using:

the CRB65 score

To the evaluation of suspected CAP (community-acquired pneumonia) the most important is:

Chest radiograph

CRB65 score include of the following prognostic features:

confusion; raised respiratory rate≥30; low blood pressure S<90mmHg, D≤60mmHg; age ≥65

Which antibiotics are contraindicated for outpatient pregnant women with community-acquired pneumonia without comorbidities?

macrolide (clarithromycin), respiratory fluoroquinolones (levofloxacin, moxifloxacin)

A diagnosis of COPD should be confirmed with:

a postbronchodilator spirometry test showing a forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7

According to GOLD Strategy-2023 severity of airflow obstruction in COPD based on post-bronchodilator FEV1 determined as GOLD 1 (Mild) if:

FEV1≥80% predicted

According to GOLD Strategy-2023 severity of airflow obstruction in COPD based on post-bronchodilator FEV1 determined as GOLD 2 (Moderate) if:

50%≤ FEV1< 80% predicted

According to GOLD Strategy-2023 severity of airflow obstruction in COPD based on post-bronchodilator FEV1 determined as GOLD 3 (Severe) if:

30%≤ FEV1< 50% predicted

According to GOLD Strategy-2023 severity of airflow obstruction in COPD based on post-bronchodilator FEV1 determined as GOLD 4 (Very severe) if:

FEV1<30% predicted

How to assess a patient with asthma:

from the frequency of daytime and night-time asthma symptom, night waking and activity limitation and, for patients using SABA reliever, their frequency of SABA use

According to GINA 2022, the most common clinical phenotypes of asthma are:

allergic asthma, non-allergic asthma, adult-onset asthma, asthma with persistent airflow limitation, asthma with obesity

It does mean significant increase in lung function after 4 weeks of antiinflammatory treatment if:

there is increase in FEV1 by >12% and >200 ml (or PEF by >20%) from baseline after 4 weeks of treatment

If patient has asthma that remains uncontrolled despite optimized treatment with high dose ICS-LABA, or that requires high dose ICS-LABA to prevent it from becoming uncontrolled, the severity of the asthma is:

severe

How asthma control changes during pregnancy in approximately?

in approximately, one-third of women asthma symptoms worsen, in onethird they improve, and in the remaining one-third they remain unchang

According to the NYHA classification system class 1 of the clinical severity of pulmonary hypertension defined if:

no limitation of physical activity; no dyspnea, fatigue, chest pain, or near syncope is present with exertion

Pulmonary hypertension is defined by:

a mean pulmonary arterial pressure of 20 mm Hg or more on a resting cardiac catheterization

According to the NYHA classification system class 4 of the clinical severity of pulmonary hypertension defined if:

inability to perform any physical activity without symptoms; dyspnea and fatigue present at rest and symptoms worsen with any activity

According to the NYHA classification system group 3 (pulmonary hypertension due to lung disease or hypoxemia) is caused by:

obstructive and restrictive lung disease, including COPD, interstitial lung disease, pulmonary fibrosis as well as other causes of chronic hypoxemia, such as sleep-disordered breathing, alveolar hypoventilation syndromes, and high-altitude exposure

What measurements are sensitive to early ironstore depletion?

measurements of bone marrow iron stores, serum ferritin, and total ironbinding capacity (TIBC)

Iron store depletion and iron deficiency are accompanied by:

a decrease in serum ferritin level below 20 µg/L

What dose of elemental iron should be given per day for iron replacement therapy?

up to 200 mg of elemental iron per day should be given

In patients with cobalamin deficiency anemia:

MCV is usually >100 fl

In patient with cobalamin deficiency may be seen in RBCs:

Howell-Jolly bodies, Cabot rings

For healthy outpatient adults without comorbidities, which antibiotics are recommended for empiric treatment of CAP (community-acquired pneumonia) as strong recommendation?

amoxicillin/clavulanate 500 mg/125 mg three times daily

In the outpatient setting, which antibiotics are recommended for empiric treatment of community-acquired pneumonia in adults with comorbidities?

amoxicillin 1 g three times daily

In outpatient adults with CAP (community-acquired pneumonia) who are improving, what is the appropriate duration of antibiotic treatment as strong recommendation?

antibiotic therapy should be continued until the patient achieves stability and for no less than a total of 5 days

Doctor should use clinical judgement in conjunction with the CRB65 score to inform decisions about whether patients with CAP (community-acquired pneumonia) need hospital assessment as follows:

consider home-based care for patients with a CRB65 score of 0

Initial treatment strategies for outpatients with community-acquired pneumonia without comorbidities or risk factors for antibiotic resistant pathogens are:

amoxicillin or doxycycline or macrolide

Doctor should use clinical judgement in conjunction with the CRB65 score to guide the management of community-acquired pneumonia, as follows:

consider hospital-based care for patients with a CRB65 score of 2 or more

In primary care mortality risk assessment in patients with communityacquired pneumonia stratifie as follows:

according to raised respiratory rate as low, intermediate and high risk

The Pneumonia severity index (PSI) stratifies patients into 5 categories based on:

patient age, comorbidities, physical examination, and results of laboratory testing

According to GOLD COPD Strategy in 2023 initial pharmacological treatment for patients group E should be:

LABA + LAMA, and consider LABA + LAMA+ICS, if blood eos ≥300

The most important therapeutic intervention for COPD is:

smoking cessation

Clinical indicators for considering a diagnosis of COPD are:

dyspnea, recurrent wheeze, chronic cough, recurrent lower respiratory tract infections, history of risk factors

The most reproducible and objective measurement of airflow obstruction are:

spirometry

The effect of SABAs (short-acting beta2-agonists) usually wears off within:

4 to 6 hours

The main side effect of inhaled anticholinergic drugs is:

dryness of mouth

As the initial bronchodilators to treat an exacerbation of COPD are recommended:

short-acting inhaled beta2-agonists, with or without short-acting anticholinergics

An exacerbation of COPD is defined as:

an event characterized by increased dyspnea and/or cough and sputum that worsens in < 14 days

According to GINA 2022, how to assess the level of asthma control, if in the past 4 weeks, has the patient had: daytime asthma symptoms not more than twice/week, not night waking due to asthma, SABA reliever for symptoms not more than twice/week, not activity limitation due to asthma?

well controlled

According to GINA 2022, how to assess the level of asthma control, if in the past 4 weeks, has the patient had: daytime asthma symptoms 1-2 times per week, night waking due to asthma 1-2 times per week, SABA reliever for symptoms 1-2 times per week, activity limitation due to asthma 1-2 times per week?

partly controlled

According to GINA 2022, how to assess the level of asthma control, if in the past 4 weeks, has the patient had: daytime asthma symptoms 3-4 times per week, night waking due to asthma 3-4 times per week, SABA reliever for symptoms 3-4 times per week, activity limitation due to asthma 3-4 times per week?

uncontrolled

According to GINA 2022, for adults in preferred Step 1-2 to control symptoms and minimize future risk should be use:

as-needed low dose ICS-formoterol

According to GINA 2022, for adults in preferred Step 3 to control symptoms and minimize future risk should be use:

low dose maintenance ICS-formoterol

According to GINA 2022, for adults in preferred Step 4 to control symptoms and minimize future risk should be use:

medium dose maintenance ICS-formoterol

According to GINA 2022, for adults in preferred Step 5 to control symptoms and minimize future risk should be use:

add-on LAMA to medium dose maintenance ICS-formoterol. Consider high dose maintenance ICS-formoterol

Post-BD increase in FEV1>12% and 400 ml from baseline (marked reversibility) is more like to confirm the following:

with high probability patient has “asthma-COPD overlap”

A decrease in mean pulmonary arterial pressure (mPAP) by ≥10 mmHg to an absolute level ≤40 mmHg without a decrease in cardiac output (CO) is defined as a positive pulmonary vasodilator response, and responders are considered for long-term treatment with:

calcium channel blockers (CCB)

Advanced therapies, such as pulmonary vasodilators, are available to treat pulmonary hypertension. The mechanisms of action for pulmonary vasodilators follow three main pathways. Which drugs belongs to the nitric oxide pathway?

phosphodiesterase inhibitors (sildenafil, tadalafil) and soluble guanylate cyclase stimulators (riociguat)

bosentan, ambrisentan

eporpostenol

ECG findings in patient with pulmonary hypertension in advanced disease can include:

right ventricular hypertrophy (right axis deviation, incomplete right bundle branch block) and right atrial enlargement (peaked P wave in the inferior and right-sided leads)

The best screening study in diagnosis of pulmonary hypertension is:

echocardiography

Patients with WHO/NYHA functional class II and III of pulmonary hypertension initially are frequently given a combination of:

endothelin receptor antagonists and phosphodiesterase inhibitors

Many symptomless patients with cobalamin deficiency are detected through the finding of a raised:

mean corpuscular volume (MCV) on a routine blood count

A spectrum of mental changes, from a change in personality to psychosis, as well as peripheral neuropathy, occur in patient with:

both folate and cobalamin deficiencies

The best treatment tactics in the asymptomatic patient with established iron deficiency anemia and an intact gastrointestinal tract is:

oral iron therapy

Cheilosis (fissures at the corners of the mouth) and koilonychia (spooning of the fingernails) are signs of:

advanced tissue iron deficiency

Normal or increased serum iron levels and transferrin saturation are characteristic of:

the thalassemias

The red blood cell distribution width (RDW) index is generally elevated in:

iron deficiency

What drugs may reduce serum vitamin B 12 concentrations by inhibiting the absorption of vitamin B12?

proton pump inhibitors, H2 receptor antagonists, metformin

Patients who have undergone gastric reduction for control of obesity or who are receiving long-term treatment with proton pump inhibitors should be screened and, if necessary, given:

cobalamin replacement

Women 33 years old complains of cough with sputum, fever up to 37,8ºC, headache, chills, weakness. She is ill for 5-6 days; there was a sore throat and general weakness. Two days later, the above complaints were accompanied by a cough, fever up to 37,80C, and shortness of breath during ordinary activity. No comorbidities. She's 14 weeks into her first pregnancy. Allergic anamnesis: no. Physical examination: general condition is satisfactory, сonsciousness is clear. Percussion in the lower part of the right lung is determined by the dulling of the pulmonary sound. Auscultative there is a weakening of breathing in the lower part of the right lung with a lot of small-bubbly wet wheezes. Respiratory rate is 24 br/min, O2Saturation 97%. On examination heart area is unchanged, HR 82 bpm, BP 120/70 mmHg. Chest X-ray: right lower lobe infiltration Determine the patient's route with SMART-CO; does the patient need outpatient treatment or a referral to hospital?

Very low risk of needing IRVS, need home-based care

Men 63 years old complains of cough with rusty sputum, shortness of breath at rest and a body temperature increase up to 39,8°C, general weakness, fatigue, feeling "foggy". He has any bad habits. Physical examination: general condition is severe, confused consciousness. Auscultative there is a weakening of breathing in the lower part of both lungs with a lot of small-bubbly wet wheezes. Respiratory rate is 32 br/min, O2Saturation 87%. Heart sounds are muffled, HR 110 bpm, BP 85/50 mmHg. Chest X-ray: both lungs lower lobes infiltration Determine the patient's route with SMART-CO; does the patient need outpatient treatment or a referral to hospital?

Very high risk of needing IRVS, need intensive care unit

A 65-year-old patient with COPD has increased dyspnea, cough, increased volume of yellow-green sputum, subfebrile body temperature. Objectively: pulse rate-28, heart rate-92. On auscultation: the lung breathing is rigid, dry whistling rales are heard. Which of the following drugs should be prescribed in this case?

amoxicillin per os

A 54-year-old patient presenting with cough, shortness of breath 3-4 times a week, nocturnal attacks up to once a week. Smoker's index is 20. Spirography revealed forced expiratory volume1-58%, after inhalation of salbutamol the airway improved by 10%. What diagnosis has the patient been given by the doctor?

chronic obstructive pulmonary disease of moderate severity

Patient T., 65 years old, has been suffering from asthma for several years, for the last 1-1.5 months complains on persistent cough, shortness of breath, daytime asthma symptoms 3-4 times a week, frequent episodes of shortness of breath at night, night waking due to asthma 3-4 times a week. He takes SABA for relief of symptoms 3-4 times a week. On examination: PEF - 55%, FEV1 - 50%. How do you assess the level of asthma control in this case?

uncontrolled

Women 49 years old, she complains to her GP on daytime asthma symptoms 2-3 times a week, waking at night 1-2 times a week. She has been suffering from asthma for several years, takes SABA for relief of symptoms 2-3 times a week at least. On examination: she talks in phrases, prefers sitting to lying, respiratory rate 28, accessory muscles not used, pulse rate 100 bpm, O2 saturation 91%, PEF 55% predicted. How do you assess worsening of asthma and exacerbation in this case?

as mild or moderate

A 28 years old women, sometimes has attacks of expiratory gasp, less than twice a month, for which she uses salbutamol inhalations to stop them. During an attack, dry whistling rales are heard in the lungs. On examination: between asthma attacks, FEV1 was 80-85% of the predicted value. Choose an initial asthma treatment:

as-needed low dose ICS-formoterol

The patient complains of shortness of breath at rest, which increases with minor physical exertion, cough with the separation of scanty purulent sputum, rapid fatigue, pain behind the sternum, which is not go on by taking nitrates, palpitations, headache, general weakness. Smokes for more than 30 years, coughs for about 20 years with phlegm, especially in the morning, and has been diagnosed with COPD for the past 15 years. Physical examination: Reduced physical tolerance. The position is forced, semi-sitting. The skin is pale, diffuse "cast-iron" cyanosis, there is an extention of the cervical veins both on inspiration and on exhalation. Barrel shaped chest. BR 30 per minute. There is weak breathing in the lungs. Percussion - extending the boundaries of relative dullness to the right and left. In auscultation, heart sounds are dull, systolic murmur along the left edge of the sternum and diastolic Graham-Still murmur over the pulmonary artery, accent II tones over the pulmonary trunk, HR is 112 beats per minute, pulse is arrhythmic. BP 140/80 mm Hg. The lower edge of the liver protrudes 4 cm from under the costal arch. Dense swelling of the feet and shins. Diuresis was reduced to 600 ml per day. Echo CG: the left and right parts of the heart are enlarged. Left ventricular EF of 62%. The trunk of the pulmonary artery and the superior vena cava are dilated. Relative tricuspid insufficiency. Hypertrophy of the walls of the right and left ventricles, dilatation of the right and left chambers of the heart. Dopplerography: systolic pressure in the pulmonary artery - 38.5 mm Hg. Spirography: pronounced obstructive type of ventilation disorder. What is your diagnosis?

pulmonary hypertension due to lung disease or hypoxemia

A 37 year old nonsmoker women complains for one year on shortness of breath, palpitation, compressive chest pain on exertion, but no cough, wheeze, sputum, haemoptysis or leg swelling. No history of HIV, chronic liver disease, deep vein thrombosis or connective tissue disease. No remarkable family history and drug history. On physical examination: she was neither cyanosed, BR 24 breaths/min at rest, pulse 96 beats/min in regular rhythm, BP 120/70 mm Hg. Her skin condition and joints were found normal and there were no stigmata of chronic liver disease or any pedal oedema. Her first heart sound was normal, but P2 was very loud in pulmonary area and there was early diastolic murmur along left sternal border and a systolic murmur in tricuspid area. There was no other murmur. Her chest radiograph showing only cardiomegaly. ECG: normal sinus rhythm, right axis deviation, right atrial enlargement and right ventricular hypertrophy. Spirometry: FVC 2.89 L (68% of predicted value), FEV1 2.08 L (69% of predicted value), FEV1/FVC 71.9% and no bronchodilator reversibility. Transthoracic Doppler echocardiogram: dilated right atrium and right ventricle. Interatrial and interventricular septa were intact with no patent ductus arteriosus flow. Mitral and aortic valves were normal. Pulmonary valve motion was suggestive of severe PH. Left ventricular cavity was reduced with normal wall thickness and wall motion with ejection fraction 55%. There was no pericardial effusion, no vegetation or thrombus. Doppler study showed grade II tricuspid regurgitation and grade 1 pulmonary regurgitaion. Pulmonary artery systolic pressure was 85 mm Hg and diastolic pressure 30 mm Hg. What is your diagnosis?

primary pulmonary hypertension

A 36 years old patient is seen by a doctor in a rural outpatient clinic. He has been on the registry for 7 years with a diagnosis of chronic enteritis. He complains of weakness, dizziness, sometimes pains near the navel and in the epigastrium, sore throat, irregular stools. On examination in general blood analysis Hb - 110g/l, RBC - 3.8×1012/l, microcytosis, anisocytosis. Diagnose the patient and decide on further treatment tactics:

intermediate iron deficiency anaemia, chronic enteritis, determine ferritin, treatment with iron supplements

A 25 year old woman has come a general practitioner with the diagnosis: Repeated pregnancy 10-11 weeks, moderate degree of iron deficiency anaemia. Treatment tactics for identified iron deficiency anaemia:

before delivery and during the whole lactation period, per os intake of iron preparations

Patient, 60 years old with a CBC: Hb-78g/l; color index-1,3; RBC2,3x1012/l; macrocytosis. Past medical history: suffers from chronic gastric and intestinal disease for a long time. What treatment should be administered to a patient with this disease?

cyanocobalamin injections on a regular basis

In acute myeloid leukemia, the initial source of excess cell growth is

Bone marrow

Chronic lymphocytic leukemia (CLL) is characterized by

Painless swelling of the lymph nodes in the neck, underarm, stomach, or groin

The presence of the Philadelphia (Ph) chromosome in samples studied by cytogenetic or molecular studies is characteristic of

Chronic myeloid leukemia

In acute myeloid leukemia, the number of blasts in the red bone marrow is

More than 20%

The 4 components of ALL treatment include:

Remission induction, consolidation, intermediate maintenance therapy, support

Which of the following is a risk factor for CVD

Man's age over 55

Which of the following applies to end organ damage

LVMI more than 125 g/m2 in men

Which of the following is an associated clinical condition

Atrial fibrillation

Which of the indicators are taken into account when stratifying risk according to the SCORE scale

SBP level, age, gender, total cholesterol level, smoking status

Which of the following is an associated clinical condition

Angina pectoris

Very high CV risk corresponds with

10-year risk of cardiovascular death by SCORE ≥10%

High CV risk corresponds with

10-year risk of cardiovascular death by SCORE ≥5-10%

Moderate CV risk corresponds with

10-year risk of cardiovascular death by SCORE ≥1-5%

Low CV risk corresponds with

10-year risk of cardiovascular death by SCORE <1%

First-line drugs for the treatment of arterial hypertension are

ACE inhibitors/ARBs

The sinoatrial node produces impulses with a frequency

60-80 bpm

The most common type of arrhythmias in the general population:

premature ventricular contractions

What group of medications reduces the risk of stroke in patients with atrial fibrillation:

anticoagulants

What type of study is the most appropriate for diagnosing rhythm disorders:

24- or 48-hour ECG monitoring

The most sensitive marker of CHF

NT-proBNP

The presence of a heart disease, the risk of CHF is high, but there is no heart dysfunction. According to the ACC/AHA/ESC classification, this stage corresponds to ...

Stage A CHF

Asymptomatic cardiac dysfunction according to the ACC/AHA/ESC classification corresponds to ...

Stage B CHF

Clinical symptoms of CHF at present or in the past (class IV according to NYHA). According to the ACC/AHA/ESC classification, this stage corresponds to ...

Stage C CHF

According to the ACC/AHA/ESC classification, this stage corresponds to the terminal stage of CHF ...

Stage D CHF

100

No effect of therapy, progressive thrombocytopenia or thrombocytosis, persistent or progressive splenomegaly, clonal evolution, increase in the number of basophils in the blood, increase in the number of blasts in the blood or bone marrow

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